8 week old with palpable abdominal mass
A hydrocele is a fluid collection within the tunica vaginalis. The tunica vaginalis is an extension of peritoneum that follows the testicle into the scrotum during development and fuses after descent. Failure of fusion at any point along the course allows fluid to accumulate in that region. This can occur anywhere along the tract, but most commonly occurs in the scrotum adjacent to the testicle. When the entire tract is unfused, peritoneal fluid freely communicates via the patent processus vaginalis into the scrotum. An abdomino-scrotal hydrocele is a rare form of a hydrocele where the entire tract is unfused, except at the deep inguinal ring. As fluid accumulates, the hydrocele can bulge into the abdominal cavity, causing both a scrotal and an abdominal component, forming an hourglass shaped cystic structure about the deep inguinal ring. Hydronephrosis and leg edema can result from compression of the ureters and iliac veins, respectively. Less likely, torsion of the proximal sac can occur. Surgical resection is recommended for abdomino-scrotal hydroceles to prevent complications.
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